Nurses in aged care facilities can detect signs of decline up to 12 months before death, but resource constraints and time pressures prevent them from providing the quality end-of-life care they know residents need, new research reveals.
The study, conducted by Flinders University’s Research Centre for Palliative Care, Death and Dying as part of the End of Life Directions for Aged Care project, interviewed nurses and care workers across 15 aged care services in three Australian states.
More than one-third of deaths among Australians aged over 65 occur in residential aged care, making end-of-life care a core aspect of nursing duties in the sector.
“As Australia’s population continues to age, nursing staff within our aged care system are at the frontline, with palliative and end-of-life care a core aspect of their job,” said lead author Dr Priyanka Vandersman from the ELDAC team.
“Just over one-third of deaths among Australians aged over 65 occur in residential aged care. With sector-wide reforms underway, including mandated care hours and 24/7 registered nurses, there is a strong need to ensure that quality care is not only being delivered, but also understood in practice.”
The research found that nurses develop the ability to identify a prolonged period of irreversible decline lasting six to twelve months before death. They rely on both clinical assessments and intuitive cues developed through long-term relationships with residents.
Early warning signs include changes in mood, behaviour, or social engagement—indicators that represent key opportunities for timely, person-centred care planning.
“Participants described this pre-terminal phase as requiring a nuanced and proactive approach,” Dr Vandersman said.
“But time pressures, documentation demands, and a resource limitation can make it difficult for nurses to act on their insights.”
Despite their expertise in recognising decline, nurses reported significant barriers to delivering consistent, high-quality end-of-life care. Some cannot remain with dying residents due to staffing shortages, while others described situations where resource limitations led to unnecessary hospital transfers.
The findings come at a critical time for the sector, with recent research from the Registry of Senior Australians and Flinders University finding no clear link between increased care minutes and improved resident experiences or clinical outcomes.
Professor Jennifer Tieman, Director of the Research Centre for Palliative Care, Death and Dying, emphasised the need for systemic change beyond staffing numbers.
“Good end-of-life care doesn’t begin in the final hours – it begins much earlier – and the system needs to recognise and support this,” Professor Tieman said.
“Nurses need support and time to identify early decline and respond with care that is aligned with each person’s needs and wishes.”
While nurses understand the components of quality end-of-life care—including early planning, open communication, emotional support, and comfort-focused practices—they struggle to deliver these consistently due to system constraints.
The study suggests that current aged care reforms, including mandated care hours and 24/7 registered nurse requirements, need to be complemented by broader support for clinical judgment, communication and person-centred care approaches.
The researchers advocate for targeted workforce training, practical support, and sector-wide cultural change to address the gap between nursing expertise and system capacity.
The findings highlight the importance of making early conversations and planning around end-of-life care a routine part of practice, ensuring care is timely, coordinated, and aligned with individual values and preferences.
Ritchelle is a Content Producer for Healthcare Channel, Australia’s premier resource of information for healthcare.
